Colleen Chappell never seemed to be able to find the time to get to the doctor for a comprehensive medical checkup. Last year, however, as her business partner battled terminal cervical cancer, Chappell decided she couldn't wait any longer. "I realized that my resolution for myself and my company needed to be protecting our most valuable asset, and that's the health of the leadership."

Trends

Younger Patients: Executive physicals aren't just for the over-50 set anymore. "Now we're starting to see people in their late 30s or early 40s come in, oftentimes prompted by a friend or loved one who had a bad health outcome and they want to try and prevent that from happening," says Dr. Stephen Avallone, who heads Cleveland Clinic Florida's executive health program in Weston.

International Appeal: Centers in Florida offering executive physicals report a significant number of international customers. Baptist Health South Florida in Miami reports that 40% of its executive health patients come from abroad, with its top feeder countries being (in order) the Bahamas, St. Kitts, the Cayman Islands, Jamaica and Honduras.

Pay Shift: As many companies restructured or downsized over the past several years, they also jettisoned some gold-plated medical benefits for CEOs. Executives, however, are choosing to pay out of pocket for the evaluations.

Chappell, who heads an advertising and public relations company in Tampa, signed up for a one-day executive physical at the University of South Florida Health's Monsour Executive Wellness Center. The checkup took about nine hours, cost $5,000 and included blood work, a vision screening, treadmill stress test, abdominal ultrasound and more. By the end of the day, Chappell learned that her risk of having a heart attack during the next 10 years was "slim to none." But an MRI of her breast had detected something abnormal. A biopsy revealed cancer at its earliest stage, stage one.

Dr. Stephen Avallone, who leads the Cleveland Clinic Florida's Huizenga Executive Health program in Weston, says: "Fifty percent of the time we're finding something of some significance that needs to be addressed so it doesn't become a problem, and 10% to 20% of the time we're finding something of more significance that needs to be addressed promptly."

Critics of such in-depth screening, however, point out that increased testing is likely to yield more false positives, leading to expensive and unnecessary treatment. Moreover, patients might even be harmed from repeat radiation exposure from CT scans and other imaging tests often used in executive physicals. In a piece he wrote in 2008 for the New England Journal of Medicine, Minneapolis oncologist Brian Rank says that executive physicals are "one of modern medicine's most expensive and least proven approaches to care."

Chappell counters that "the cost of the exam is nominal compared to what it costs to be sick. If I had not had this physical, the costs for me to have waited would have been five times more healthcare costs, because (the breast cancer) would have been stage three. The cost also would be 10 times more time out of the office."

Even those without life-or-death experiences still see value in the comprehensive executive exams.